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Employment Application
Step 1 of 2
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APPLICANT INFORMATION
Full Name
*
First
Middle
Last
Present Address
*
Street Address
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State
ZIP Code
Home Phone
*
Cell Phone
Email Address
*
Position applied for
*
Current employee referral?
*
Yes
No
If so, name of that employee:
*
Special training or skills (languages, machine operations, etc.) that would benefit you in the job for which you are applying:
Would you accept full-time work?
*
Yes
No
Would you accept part-time work?
*
Yes
No
On what date, would you be available for work?
*
Have you ever been employed here?
*
Yes
No
If yes, dates:
Are you legally eligible for employment in the United States? (If yes, proof is required if hired.)
*
Yes
No
If you are under 18 years old, can you provide a work permit if required?
Yes
No
EDUCATION BACKGROUND
High School:
Location
Course of study
Did you graduate?
Yes
No
Degree or diploma
College:
Location
Course of study
Did you graduate?
Yes
No
Degree or diploma
Graduate School:
Location
Course of study
Did you graduate?
Yes
No
Degree or diploma
Vocational Training/Other:
Location
Course of study
Did you graduate?
Yes
No
Degree or diploma
Continuing Education:
EMPLOYMENT EXPERIENCE
List your most recent employer first.
Employer
Contact Name
May we contact?
Yes
No
Address
Phone
Job Title
Hourly rate/salary
Date employed from (mm/yy):
Date employed to (mm/yy):
Employer
Contact Name
May we contact?
Yes
No
Address
Phone
Job Title
Hourly rate/salary:
Date employed from (mm/yy):
Date employed to (mm/yy):
Employer
Contact Name
May we contact?
Yes
No
Address
Phone
Job Title
Hourly rate/salary:
Date employed from (mm/yy):
Date employed to (mm/yy):
Employer
Contact Name
May we contact?
Yes
No
Address
Phone
Job Title
Hourly rate/salary:
Date employed from (mm/yy):
Date employed to (mm/yy):
I certify that all the information submitted by me on this application is true and complete, and I understand that if any false or misleading information, omissions or misrepresentations are discovered, my application may be rejected, and if I am employed, my employment may be terminated at any time.
If hired, I agree to conform to the company’s rules and regulations, and I understand that these rules and/or employee handbook do not form a contract of employment either expressed or implied, and I agree that my employment and compensation can be terminated, with or without cause and with or without notice, at any time, at either my or the company’s option.
I also understand and agree that the terms and conditions of my employment may be changed, with or without cause and with or without notice, at any time by the company. I understand that no company representative, other than its president, and then only when in writing and signed by the president, has any authority to enter into any agreement for employment for any specific period of time, or to make any agreement contrary to the forgoing.
I expressly authorize, without reservation, the employer, its representative, employees or agents to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, resume or job interview.
I hereby waive any and all rights and claims I may have regarding the employer, its agents, employees or representative, for seeking, gathering and using truthful and non-defamatory information, in a lawful manner, in the employment process and all other persons, corporations or organizations for furnishing such information about me.
I understand that this application remains current for only 30 days. At the conclusion of that time, if I have not heard from the employer and still wish to be considered for employment, it will be necessary for me to reapply and fill out a new application.
Agreement
*
I agree
Applicant's Signature
*
Date
*
Farm Service Coop
2303 Pine Street
Harlan, IA 51537
712-755-3185
MVR Release Authorization
Personal and Employment Background Check
Date
*
Branch Office
Name of Applicant/Employee
*
Address
*
Street Address
City
State / Province / Region
ZIP / Postal Code
Driver License Number
CDL?
Yes
No
Exp. Date
State
Hazmat / Tank
Yes
No
Other Endorsements
Date of Birth
MM
DD
YYYY
Social Security Number
Phone Number
Cell Number
Current DOT Physical
Yes
No
Expiration Date
My Driving Record along with my personal and employment background may be obtained as part of the Farm Service Cooperative’s evaluation of my job application/employment. The reports may be procured by Farm Service Cooperative, and may include my driving record and an assessment of my insurability under the Company’s insurance coverage’s. By signing this disclosure, I hereby authorize the Company to procure such reports about me from time to time, as it deems appropriate, to evaluate my insurability or for other permissible purposes.
Authorization
*
I agree
Electronic Signature of Job Applicant/Employee
*
Email
This field is for validation purposes and should be left unchanged.
Reach Farm Service Cooperative
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Tel:
1-712-755-3185
✉
Email:
info@fscoop.com
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Address:
PO Box 429, 2308 Pine Street, Harlan, Iowa 51537
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